Abstract: BACKGROUND: Neurorehabilitation covers a large range of disorders, assessment approaches and treatment methods. There have been previous citation analyses of rehabilitation and of its subfields. However, there has never been a comprehensive citation analysis in neurorehabilitation. OBJECTIVE: The present study reports findings from a citation analysis of the top 100 most cited neurorehabilitation papers to describe the research trends in the field. METHODS: A de-novo keyword search of papers indexed in the Web of Science Core Collection database yielded 52,581 papers. A candidate pool of the 200 most-cited papers published between 2005 and 2016…was reviewed by the clinician authors. The papers in the top 100 deemed to be irrelevant were discarded and replaced by the most highly-cited articles in the second tier deemed to be clinically relevant. RESULTS: The most frequently cited neurorehablitation papers appeared in Stroke, Movement Disorders, and Neurology . Papers tended to focus on treatments, especially for stroke. Authorship trends suggest that top cited papers result from group endeavors, with 90% of the papers involving a collaboration among 3 or more authors. CONCLUSION: Treatment studies, often focused on stroke, appear to have the highest impact in the field of neurorehabilitation.
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Abstract: BACKGROUND: Transfer of skills learned within the clinic environment to patients’ home or community is important in post-inpatient brain injury rehabilitation (PBIR). Outcome measures used in PBIR assess level of independence during functional tasks; however, available functional instruments do not quantitate the environment in which the behaviors occur. OBJECTIVE: To examine the reliability and validity of an instrument used to assess patients’ functional abilities while quantifying the amount of structure and distractions in the environment. METHODS: 2501 patients who sustained a traumatic brain injury (TBI) or cerebrovascular accident (CVA) and participated in a multidisciplinary PBIR…program between 2006 and 2014 were identified retrospectively for this study. The PERPOS and MPAI-4 were used to assess functional abilities at admission and at discharge. Construct validity was assessed using a bivariate Spearman rho analysis A subsample of 56 consecutive admissions during 2014 were examined to determine inter-rater reliability. Intra-class correlation coefficient (ICC) and Kappa coefficients assessed inter-rater agreement of the total PERPOS and PERPOS subscales respectively. RESULTS: The PERPOS and MPAI-4 demonstrated a strong negative association among both TBI and CVA patients. Kappa scores for the three PERPOS scales each demonstrated good to excellent inter-rater agreement. The ICC for overall PERPOS scores fell in the good agreement range. CONCLUSION: The PERPOS can be used reliably in PBIR to quantify patients’ functional abilities within the context of environmental demands.
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Abstract: BACKGROUND: Previous studies have investigated the use of transcranial direct current stimulation (tDCS) for pain management. The studies investigating therapeutic neuromodulation with tDCS for lower extremity pain are scarce and inconclusive. OBJECTIVE: The aim of the present study was to analyze the effects of cerebellar tDCS on lower extremity sensory and pain thresholds in healthy volunteers. METHODS: This was a single-blind crossover repeated-measure study. Utilizing randomized conditions, we examined the effects of anodal, cathodal and sham stimulation of the right cerebellum in 14 healthy volunteers on sensory and pain thresholds which were induced in the…right leg using electrical stimulation. tDCS intensity was 2 mA and the duration of the stimulation was 10 minutes. RESULTS: After anodal cerebellar stimulation the pain threshold of the ipsilateral leg was increased (p < 0.01). We could not detect any significant pain modulation with cathodal or sham stimulation (p > 0.05). Furthermore, no significant modulation of the sensory threshold was detected after anodal, cathodal or sham cerebellar tDCS (p > 0.05). CONCLUSIONS: Our results indicate that anodal cerebellar tDCS with a reference electrode positioned over the buccinator area modulates pain processing in the ipsilateral leg. Further investigation is required to evaluate possible application in chronic pain patients.
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Abstract: BACKGROUND: The Chedoke Arm and Hand Activity Inventory (CAHAI) is an assessment of upper limb function designed for use in the stroke population. The CAHAI has strong reliability and validity in this population; however, it is unknown whether this measure can be used with other clinical populations such as acquired brain injury (ABI). PURPOSE: The purpose of this study was to estimate the inter-rater reliability of the CAHAI when used with persons with ABI. METHODS: The research design was an observational parameter estimation study. The administration of the CAHAI was videotaped for 6 persons with…ABI. To estimate inter-rater reliability each video was assessed independently by 6 clinicians yielding a total of 36 assessments. A Latin square design was used to balance the order raters evaluated the videos. Shrout and Fleiss Type 2,1 intra class correlation coefficients (ICC) and standard error of measurement (SEM) were calculated to estimate inter-rater reliability of the CAHAI. RESULTS: Inter-rater reliability was high ICC = 0.96 (95% CL: 0.88, 0.99) and the SEM was 3.35 (95% CL: 2.63, 4.63) CAHAI points. CONCLUSIONS: These results suggest that the CAHAI, although designed for use in the stroke population, can be used reliably in the ABI population.
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Abstract: OBJECTIVE: To assess burden and life satisfaction in family members of patients with severe traumatic brain injury (sTBI) at 1 and 2 years post-injury, examine if change in burden can be predicted by family member and patient demographics, patient’s functional status, family members social network or level of burden at 1 year. METHODS: Prospective national multicenter study. Self-report from family members, patient data collected from a national cohort study on patients with sTBI. 80 family members participated. MAIN OUTCOME MEASURE: The Caregiver Burden Scale (CBS), life satisfaction. RESULTS: Total burden increased between years 1 and 2 post-injury…(P = 0.04). Thirty percent of the family members reported an increased burden, 55% were stable, and 15% had a decrease in burden between the two follow-up times. Logistic regression analyses revealed that experiencing loneliness was an independent predictor of increased burden from 1 to 2 years post-injury (OR = 4.35, P < 0.05). Life Satisfaction was lower at the 2 year follow-up than at 1 year (p = 0.03). CONCLUSIONS: The results demonstrate a need for long-term follow-up of patients and family members that focuses on professional support to relieve burden and risk of loneliness or social isolation. This group may benefit from additional follow-up interventions tailored to their needs.
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Abstract: BACKGROUND: Post-stroke rehabilitation should begin immediately and continue while improvement is seen. After stroke, patients are at risk of developing medical complications, which can hinder optimal recovery. OBJECTIVE: We aimed to determine the incidence of complications occurring during early inpatient rehabilitation and to assess their influence on patients’ functionality. METHODS: For 1075 patients (585 men), we recorded neurological deficits, activities of everyday living, functionality before and after rehabilitation, and the incidence of complications. The main measure of functional outcome was the discharge Barthel Index score. RESULTS: At least one complication was reported by…76.9% of patients, and 20% experienced three or more complications. The most common problems were: urinary tract infection (23.2%), depression (18.9%), falls (17.9%), unstable hypertension (17.6%), and shoulder pain (14.9%). Patients with a severe discharge disability were 2.5-fold more likely to experience complications than subjects with a mild disability. CONCLUSIONS: Complications during the post stroke rehabilitation process had a significantly decreased chance for improvement. Knowledge of the most common type of complications, as well as their early prevention and treatment, may improve patient outcomes.
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Abstract: BACKGROUND: Although extensive research has been published about the emotional consequences of stroke, most studies have focused on emotional words, speech prosody, voices, or facial expressions. The emotional processing of musical excerpts following stroke has been relatively unexplored. OBJECTIVE: The present study was conducted to investigate the effects of chronic stroke on the recognition of basic emotions in music. METHODS: Seventy persons, including 25 normal controls (NC), 25 persons with right brain damage (RBD) from stroke, and 20 persons with left brain damage (LBD) from stroke between the ages of 31–71 years were studied. The…Musical Emotional Bursts (MEB) test, which consists of a set of short musical pieces expressing basic emotional states (happiness, sadness, and fear) and neutrality, was used to test musical emotional perception. RESULTS: Both stroke groups were significantly poorer than normal controls for the MEB total score and its subtests (p < 0.001). The RBD group was significantly less able than the LBD group to recognize sadness (p = 0.047) and neutrality (p = 0.015). Negative correlations were found between age and MEB scores for all groups, particularly the NC and RBD groups. CONCLUSION: Our findings indicated that stroke affecting the auditory cerebrum can cause acquired amusia with greater severity in RBD than LBD. These results supported the “valence hypothesis” of right hemisphere dominance in processing negative emotions.
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Abstract: BACKGROUND: Population ageing and changes in the epidemiological profile of neurological pathologies has resulted in an increase in patients with disabilities. Rehabilitation strategies such as Modified Constraint-Induced Movement Therapy (CIMTm) play a key role in treating patients with neurologic deficiencies and motor impairments. This intervention is intended to mitigate disability, promote maximum functional independence, and optimize social and economic participation of patients with upper extremity weakness. Our goal was to assess the recovery of functional independence in patients after a stroke using to CIMTm. PATIENTS AND METHOD: Thirty-six subjects who had suffered stroke took part in a…randomised clinical trial. The treatment was applied through either collective or individual modalities for three hours per day for a period of ten days. Participant’s functional independence was assessed using the Functional Independence Measure (FIM) scale at the before and after of the intervention. RESULTS: An analysis of covariance carried out on the pre-test assessments indicates that the dependent variable presents significant differences (F 1.31 = 42.78, p < 0.001, η 2 p = 0.72) in favour of the collective intervention modality. CONCLUSION: Both modalities of CIMTm intervention promote functional independence. However, the greatest improvements were observed in participants in the collective modality. Improvements in functional independence pursue a reduction in learned non-use behaviours through greater use of the paretic upper extremity in everyday activities.
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Abstract: BACKGROUND: Recent studies have shown that stimulation of the peroneal nerve using an implantable 4-channel peroneal nerve stimulator could improve gait in stroke patients. OBJECTIVES: To assess structural cortical and regional cerebral metabolism changes associated with an implanted peroneal nerve electrical stimulator to correct foot drop related to a central nervous system lesion. METHODS: Two stroke patients presenting a foot drop related to a central nervous system lesion were implanted with an implanted peroneal nerve electrical stimulator. Both patients underwent clinical evaluations before implantation and one year after the activation of the stimulator. Structural magnetic…resonance imaging (MRI) and [18F]-fluorodeoxyglucose-positron emission tomography (FDG-PET) were acquired before and one year after the activation of the stimulator. RESULTS: Foot drop was corrected for both patients after the implantation of the stimulator. After one year of treatment, patient 1 improved in three major clinical tests, while patient 2 only improved in one test. Prior to treatment, FDG-PET showed a significant hypometabolism in premotor, primary and supplementary motor areas in both patients as compared to controls, with patient 2 presenting more widespread hypometabolism. One year after the activation of the stimulator, both patients showed significantly less hypometabolism in the damaged motor cortex. No difference was observed on the structural MRI. CONCLUSION: Clinical improvement of gait under peroneal nerve electrical stimulation in chronic stroke patients presenting foot drop was paralleled to metabolic changes in the damaged motor cortex.
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